Healthcare Provider Details

I. General information

NPI: 1578948287
Provider Name (Legal Business Name): SUVENDRA VIJAYAN B.D.S, M.P.H, M.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2015
Last Update Date: 10/25/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 TERRACE ST SALK ANNEX G119
PITTSBURGH PA
15213-2523
US

IV. Provider business mailing address

3501 TERRACE ST SALK ANNEX G119
PITTSBURGH PA
15213-2523
US

V. Phone/Fax

Practice location:
  • Phone: 412-624-2053
  • Fax:
Mailing address:
  • Phone: 412-624-2053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0008X
TaxonomyOral and Maxillofacial Radiology Dentistry
License NumberRFD000032
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code1223X0008X
TaxonomyOral and Maxillofacial Radiology Dentistry
License NumberRES-30448
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: